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Hip structural geometry and incidence of hip fracture in postmenopausal women: what does it add to conventional bone mineral density?

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Abstract

Summary

Hip geometry measurements of outer diameter and buckling ratio at the intertrochanter and shaft of the hip dual energy X-ray absorptiometry (DXA) scan predicted incident hip fracture in postmenopausal women. These associations, independent of age, body size, clinical risk factors, and conventional areal bone mineral density, suggest hip geometry plays a role in fracture etiology and may aid in improving identification of older women at high fracture risk.

Introduction

This study examined whether hip geometry parameters predicted hip fracture independent of body size, clinical risk factors, and conventional femoral neck bone mineral density (aBMD) and whether summary factors could be identified to predict hip fracture.

Methods

We studied 10,290 postmenopausal women from the Women's Health Initiative. Eight thousand eight hundred forty-three remained fracture free during follow-up to 11 years of follow-up, while 147 fractured their hip, and 1,300 had other clinical fractures. Hip structural analysis software measured bone cross-sectional area, outer diameter, section modulus, average cortical thickness, and buckling ratio on archived DXA scans in three hip regions: narrow neck, intertrochanter, and shaft. Hazard ratios were estimated using Cox proportional hazards models for individual parameters and for composite factors extracted from principal components analysis from all 15 parameters.

Results

After adjustment for age, body size, clinical risk factors, and aBMD, intertrochanter and shaft outer diameter measurements remained independent predictors of hip fracture with hazard ratios for a one standard deviation increase of 1.61 (95% confidence interval (CI), 1.25–2.08) for the intertrochanter and 1.36 (95% CI, 1.06–1.76) for the shaft. Average buckling ratios also independently predicted incident hip fracture with hazard ratios of 1.43 (95% CI, 1.10–1.87) at the intertrochanter and 1.24 (95% CI, 1.00–1.55) at the shaft. Although two composite factors were extracted from principal components analysis, neither was superior to these individual measurements at predicting incident hip fracture.

Conclusions

Two hip geometry parameters, intertrochanter outer diameter and buckling ratio, predict incident hip fracture after accounting for clinical risk factors and aBMD.

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Acknowledgments

Short list of WHI investigators

Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller.

Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, Anne McTiernan; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker; (Medical Research Labs, Highland Heights, KY) Evan Stein; (University of California at San Francisco, San Francisco, CA) Steven Cummings.

Clinical Centers: (Albert Einstein College of Medicine, Bronx, NY) Sylvia Wassertheil-Smoller; (Baylor College of Medicine, Houston, TX) Jennifer Hays; (Brigham and Women's Hospital, Harvard Medical School, Boston, MA) JoAnn Manson; (Brown University, Providence, RI) Annlouise R. Assaf; (Emory University, Atlanta, GA) Lawrence Phillips; (Fred Hutchinson Cancer Research Center, Seattle, WA) Shirley Beresford; (George Washington University Medical Center, Washington, DC) Judith Hsia; (Los Angeles Biomedical Research Institute at Harbor- UCLA Medical Center, Torrance, CA) Rowan Chlebowski; (Kaiser Permanente Center for Health Research, Portland, OR) Evelyn Whitlock; (Kaiser Permanente Division of Research, Oakland, CA) Bette Caan; (Medical College of Wisconsin, Milwaukee, WI) Jane Morley Kotchen; (MedStar Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Northwestern University, Chicago/Evanston, IL) Linda Van Horn; (Rush Medical Center, Chicago, IL) Henry Black; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (State University of New York at Stony Brook, Stony Brook, NY) Dorothy Lane; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Alabama at Birmingham, Birmingham, AL) Cora E. Lewis; (University of Arizona, Tucson/Phoenix, AZ) Tamsen Bassford; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of California at Davis, Sacramento, CA) John Robbins; (University of California at Irvine, CA) F. Allan Hubbell; (University of California at Los Angeles, Los Angeles, CA) Howard Judd; (University of California at San Diego, LaJolla/Chula Vista, CA) Robert D. Langer; (University of Cincinnati, Cincinnati, OH) Margery Gass; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Hawaii, Honolulu, HI) David Curb; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Massachusetts/Fallon Clinic, Worcester, MA) Judith Ockene; (University of Medicine and Dentistry of New Jersey, Newark, NJ) Norman Lasser; (University of Miami, Miami, FL) Mary Jo O’Sullivan; (University of Minnesota, Minneapolis, MN) Karen Margolis; (University of Nevada, Reno, NV) Robert Brunner; (University of North Carolina, Chapel Hill, NC) Gerardo Heiss; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (University of Tennessee, Memphis, TN) Karen C. Johnson; (University of Texas Health Science Center, San Antonio, TX) Robert Brzyski; (University of Wisconsin, Madison, WI) Gloria E. Sarto; (Wake Forest University School of Medicine, Winston-Salem, NC) Denise Bonds; (Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI) Susan Hendrix.

Source of funding: Supported by a grant from the National Institute on Arthritis and Musculoskeletal Diseases R01 AR049411. The Women's Health Initiative is funded by the National Heart Lung and Blood Institute of the US Department of Health and Human Services.

Conflicts of interest

The HSA software used in the study was licensed to Hologic by Johns Hopkins University. No other conflicts of interests are reported.

Author information

Authors and Affiliations

  1. WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    A. Z. LaCroix

  2. Department of Radiology, The Johns Hopkins University, Baltimore, MD, USA

    T. J. Beck

  3. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    J. A. Cauley

  4. Division of Preventive Medicine, University of Alabama, Birmingham, AL, USA

    C. E. Lewis

  5. Department of Family and Community Medicine, University of Arizona, Tucson, AZ, USA

    T. Bassford

  6. Division of Endocrinology, Ohio State University, Columbus, OH, USA

    R. Jackson

  7. Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

    G. Wu & Z. Chen

  8. Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-A410, P.O. Box 19024, Seattle, WA, 98109-1024, USA

    A. Z. LaCroix

  9. University of Arizona, 1295 N. Martin, Room 230, Tucson, AZ, 85724-5211, USA

    Z. Chen

Authors
  1. A. Z. LaCroix
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  2. T. J. Beck
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  3. J. A. Cauley
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  4. C. E. Lewis
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  5. T. Bassford
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  6. R. Jackson
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  7. G. Wu
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  8. Z. Chen
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Corresponding authors

Correspondence to A. Z. LaCroix or Z. Chen.

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LaCroix, A.Z., Beck, T.J., Cauley, J.A. et al. Hip structural geometry and incidence of hip fracture in postmenopausal women: what does it add to conventional bone mineral density?. Osteoporos Int 21, 919–929 (2010). https://doi.org/10.1007/s00198-009-1056-1

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  • DOI: https://doi.org/10.1007/s00198-009-1056-1

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